Posterior Lamellar Eyelid Reconstruction With Acellular Dermis Allograft in Severe Cicatricial Entropion

Abstract

Severe cicatricial entropion is a serious condition, which may threaten the vision of the affected patient. To date, surgical repair of this condition has been difficult and associated with a high degree of failure. From February 2005 to February 2006, a prospective cohort study was conducted in which 14 patients with severe cicatricial entropion were recruited. Lengthening of the posterior lamella of the eyelid with acellular dermis allograft (ReDerm, Jieya company, Beijing, PR China) was performed followed by use of therapeutic contact lenses at the end of surgery. The patients were followed up regularly and were assessed for structural integrity, upper marginal reflex distance (U-MRD), vertical palpebral aperture, and lagophthalmos. The mean follow-up time was 18 months. Acellular dermis was effective in reducing the palpebral aperture (P = 0.002), lagophthalmos (P = 0.016), and lengthening the upper eyelid height by reducing U-MRD (P = 0.008). However, there were 2 cases of recurrence because of the shrinkage of graft (70%) and 3 cases of conjunctival granulomas postoperatively. Final outcome was good in 14 of 16 eyelids. We have found that acellular dermis grafting with insertion of therapeutic contact lenses is an effective and simple measure for rectifying severe cicatricial entropion both structurally and functionally.

Modified tarsotomy for the treatment of severe cicatricial entropion

“…14 Terminal tarsal rotation and posterior lamellar eyelid reconstruction with acellular dermis allograft for severe cicatricial entropion was successful in 14 of 16 eyelids. 13 This technique is similar to our technique except it is combined with posterior lamellar lengthening with acellular dermis allograft but takes more time. Seiff et al 19 reported a functional success rate of 100% for upper eyelid tarsal margin rotation and extended posterior lamellae superadvancement, which is based on a combination of eyelid margin rotation and lamellar splitting of anterior and posterior lamellae.…”

“…Posterior lamella lengthening requires the use of posterior and middle lamella grafts to restore a smooth surface for globe contact and therefore might take more time. [13][14][15][16][17] Our technique of tarsotomy is based on the principle of eyelid margin rotation or eversion. Transverse tarsotomy and lid margin rotation is a simple procedure that effectively repositions the entropic lid margin without external incisions or grafting.…”

“…Furthermore, relatively few studies have been undertaken on severe cicatricial entropion. 11,13,14,17 In the present study, we only included patients with severe cicatricial entropion, defined as 'gross entropion with tarsal deformity and conjunctival scarring' by Kemp and Collin. 1 Entropion is considered mild if the tarsal plate appears grossly to be in a normal position but with conjunctivalization of the lid margin and lash/globe contact only when gaze is directed toward the involved eyelid.…”

Autologous dermis graft versus conchal cartilage graft for managing lower eyelid retraction: A comparative study

“…3 Among autologous grafts, hard palate mucosa and conchal cartilage are the most commonly used spacers. [4][5][6][7][8][9][10][11][12][13] However, donor site morbidity when collecting hard palate mucosa 14 and eyelid contour abnormalities associated with conchal cartilage graft are limiting factors. Acellular dermis allografts and xenografts are very promising because they allow reducing morbidity and the operative time with satisfactory outcomes.…”

“…Acellular dermis allografts and xenografts are very promising because they allow reducing morbidity and the operative time with satisfactory outcomes. 1,4,6,9,15 However, a prospective comparative study has shown a higher retraction rate with acellular dermis allografts compared to autologous hard palate mucosal grafts. 16 In addition, acellular dermis grafts are expensive and hardly available in many countries, including France.…”